認知症高齢者の意欲低下に関連する脳血流分布

目的:認知症高齢者の日常生活機能に関する意欲の変化に呼応する脳血流変化を脳血流SPECT検査を用い画像統計解析し,脳内における生活意欲関連領域を特定する.方法:対象は杏林大学病院もの忘れセンターを受診した患者で,うつ状態と前頭側頭型認知症の症例を除外し,抗うつ薬,向精神薬,漢方薬,抗認知症薬,脳循環代謝改善薬の服用をしていない患者123名(男性39名,女性84名,77.7±6.7歳)である.意欲を評価するためにVitality Index(以下VI)を行い,併せて99mTc-ECDによる脳血流SPECT検査を施行した.結果:(1)総合的機能評価ではVI 9.0±1.3点と軽度の意欲低下を認めた...

Full description

Saved in:
Bibliographic Details
Published in日本老年医学会雑誌 Vol. 45; no. 6; pp. 615 - 621
Main Authors 鳥羽, 研二, 園原, 和樹, 長谷川, 浩, 守屋, 祐貴子, 中居, 龍平, 小林, 義雄, 神崎, 恒一, 松田, 博史
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本老年医学会 2008
Subjects
Online AccessGet full text
ISSN0300-9173
DOI10.3143/geriatrics.45.615

Cover

Abstract 目的:認知症高齢者の日常生活機能に関する意欲の変化に呼応する脳血流変化を脳血流SPECT検査を用い画像統計解析し,脳内における生活意欲関連領域を特定する.方法:対象は杏林大学病院もの忘れセンターを受診した患者で,うつ状態と前頭側頭型認知症の症例を除外し,抗うつ薬,向精神薬,漢方薬,抗認知症薬,脳循環代謝改善薬の服用をしていない患者123名(男性39名,女性84名,77.7±6.7歳)である.意欲を評価するためにVitality Index(以下VI)を行い,併せて99mTc-ECDによる脳血流SPECT検査を施行した.結果:(1)総合的機能評価ではVI 9.0±1.3点と軽度の意欲低下を認めた.またMMSE 22.1±5.1点と軽度の認知機能の低下を認めた.(2)Statistical Parametric Mapping(SPM)を用いた意欲低下と脳血流変化(相対値)に関する解析では,意欲の低下と関連を認めた領域は両側の横側頭回,上側頭回,中側頭回,レンズ核と,右側の眼窩回,内前頭回,下前頭回,前部帯状回,帯状回,尾状核頭および左側の視床,尾状核であった.(3)Three-dimensional stereotaxic ROI template(3DSRT)を用いた意欲低下と脳血流変化(絶対値)に関する解析では,意欲の低下と関連した脳血流低下領域は両側の前部帯状回,眼窩回,直回,上側頭回,横側頭回,海馬傍回,尾状核頭,視床下部と,左側の中側頭回,梁下野,扁桃体,視床,右側の帯状回であった.この中で眼窩回は,もっとも関連が強かった.結論:相対値及び絶対値の検討から,意欲の低下を来す脳血流変化として,眼窩回を中心とする前頭葉が重要であるが,大脳辺縁系や白質の血流障害が関連する可能性が示唆された.
AbstractList 目的:認知症高齢者の日常生活機能に関する意欲の変化に呼応する脳血流変化を脳血流SPECT検査を用い画像統計解析し,脳内における生活意欲関連領域を特定する.方法:対象は杏林大学病院もの忘れセンターを受診した患者で,うつ状態と前頭側頭型認知症の症例を除外し,抗うつ薬,向精神薬,漢方薬,抗認知症薬,脳循環代謝改善薬の服用をしていない患者123名(男性39名,女性84名,77.7±6.7歳)である.意欲を評価するためにVitality Index(以下VI)を行い,併せて99mTc-ECDによる脳血流SPECT検査を施行した.結果:(1)総合的機能評価ではVI 9.0±1.3点と軽度の意欲低下を認めた.またMMSE 22.1±5.1点と軽度の認知機能の低下を認めた.(2)Statistical Parametric Mapping(SPM)を用いた意欲低下と脳血流変化(相対値)に関する解析では,意欲の低下と関連を認めた領域は両側の横側頭回,上側頭回,中側頭回,レンズ核と,右側の眼窩回,内前頭回,下前頭回,前部帯状回,帯状回,尾状核頭および左側の視床,尾状核であった.(3)Three-dimensional stereotaxic ROI template(3DSRT)を用いた意欲低下と脳血流変化(絶対値)に関する解析では,意欲の低下と関連した脳血流低下領域は両側の前部帯状回,眼窩回,直回,上側頭回,横側頭回,海馬傍回,尾状核頭,視床下部と,左側の中側頭回,梁下野,扁桃体,視床,右側の帯状回であった.この中で眼窩回は,もっとも関連が強かった.結論:相対値及び絶対値の検討から,意欲の低下を来す脳血流変化として,眼窩回を中心とする前頭葉が重要であるが,大脳辺縁系や白質の血流障害が関連する可能性が示唆された.
Author 守屋, 祐貴子
中居, 龍平
松田, 博史
神崎, 恒一
長谷川, 浩
小林, 義雄
園原, 和樹
鳥羽, 研二
Author_xml – sequence: 1
  fullname: 鳥羽, 研二
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 園原, 和樹
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 長谷川, 浩
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 守屋, 祐貴子
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 中居, 龍平
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 小林, 義雄
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 神崎, 恒一
  organization: 杏林大学医学部高齢医学
– sequence: 1
  fullname: 松田, 博史
  organization: 埼玉医科大学病院核医学診療科
BookMark eNpFj71Kw1AYhs9QwVp7AV5E4jmenK85k0ixKhRcdA7fiUlNqVWSLG6JVi0UdfNnEisuVhwUoUuvJm2a3IWFii7vs7w88CyRQvu47RCywqjOmcFXG47vYeh7dqAbQgcmCqRIOaWaZBW-SMpB4CkqTEMaALRI1rO36-nT6_T-Kh885KN-Fl0k8UfauU3fP8ejm_Gwl8SD_K6fRy9J_Jic9bLOV_Ycpd_xpHs5GZ4vkwUXW4FT_mWJ7Nc296rbWn13a6e6UdeazATUXAMkcJQKhTJNoNI1pS2Vw7jtzkCxYitAEMABJYcDl60JFMjMiqLocsVLpDb3NoMQG4514ntH6J9a6Iee3XKs_2zLEBbMZ1b_d7AP0beayH8A44RwfQ
ContentType Journal Article
Copyright 2008 一般社団法人 日本老年医学会
Copyright_xml – notice: 2008 一般社団法人 日本老年医学会
DOI 10.3143/geriatrics.45.615
DatabaseTitleList
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EndPage 621
ExternalDocumentID article_geriatrics_45_6_45_6_615_article_char_ja
GroupedDBID 123
2WC
ALMA_UNASSIGNED_HOLDINGS
CS3
F5P
JSF
KQ8
OK1
RJT
ID FETCH-LOGICAL-j186a-f46963a9ba5b88609f89c9be13cf9be0a7cb6a65636a936df125a5a187b0af3b3
ISSN 0300-9173
IngestDate Wed Sep 03 06:30:15 EDT 2025
IsDoiOpenAccess true
IsOpenAccess true
IsPeerReviewed false
IsScholarly true
Issue 6
Language Japanese
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-j186a-f46963a9ba5b88609f89c9be13cf9be0a7cb6a65636a936df125a5a187b0af3b3
OpenAccessLink https://www.jstage.jst.go.jp/article/geriatrics/45/6/45_6_615/_article/-char/ja
PageCount 7
ParticipantIDs jstage_primary_article_geriatrics_45_6_45_6_615_article_char_ja
PublicationCentury 2000
PublicationDate 2008
PublicationDateYYYYMMDD 2008-01-01
PublicationDate_xml – year: 2008
  text: 2008
PublicationDecade 2000
PublicationTitle 日本老年医学会雑誌
PublicationTitleAlternate 日老医誌
PublicationYear 2008
Publisher 一般社団法人 日本老年医学会
Publisher_xml – name: 一般社団法人 日本老年医学会
References 12) Takeuchi R, Yonekura Y, Matsuda H, Konishi J: Usefulness of a three-dimensional stereotaxic ROI template on anatomically standardised 99mTc-ECD SPET. Eur J Nucl Med Mol Imaging 2002; 29: 331-341.
6) Sheikh JI, Yesavage JA: Geriatric depression scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontol 1986; 56: 165-173.
5) Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 1993; 50: 873-880.
15) Talairach J, Tournoux P: Co-planar stereotaxic atlas of the human brain. Thieme Verlag, Stuttgart 1998.
16) Starkstein SE, Ingram L, Garau ML, Mizrahi R: On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry 2005; 76: 1070-1074.
20) Benoit M, Dygai I, Migneco O, Robert PH, Bertogliati C, Darcourt J, et al.: Behavioral and psychological symptoms in Alzheimer's disease: Relation between apathy and regional cerebral perfusion. Dement Geriatr Cogn Disord 1999; 10: 511-517.
24) Tatemichi TK, Desmond DW, Prohovnik I: Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995; 45: 371-385.
23) Hirao K, Ohnishi T, Hirata Y, Yamashita F, Mori T, Moriguchi Y, et al.: The prediction of rapid conversion to Alzheimer's disease in mild cognitive impairment using regional cerebral blood flow SPECT. Neuroimage 2005; 1014-1021.
25) Levy R, Czernecki V: Apathy and the Basal Ganglia. J Neurol 2006; 253: vii54-vii61.
27) 小林祥泰: 脳血管性認知症の治療と予防: 老年期認知症の克服をめざして. 長寿科学振興財団, 2002, p216-218.
2) Okada K, Kobayashi S, Yamagata S, Takahashi K, Yamaguchi S: Poststroke apathy and regional cerebral blood flow. Stroke 1997; 28: 2437-2441.
10) Toba K, Nakai R, Akishita M, Iijima S, Nishinaga M, Mizoguchi T, et al.: Vitality index as a useful tool to assess elderly with dementia. Geriatrics and Gerontology International 2002; 2: 23-29.
13) Takeuchi R, Sengoku T, Matsumura K: Usefulness of fully automated constant ROI analysis software for the brain: 3DSRT and FineSRT. Radiat Med 2006; 24: 538-544.
8) Folstein MF, Folstein SE, McHugh PR, Mini-Mental State: A practical method for grading the cognitive state of patients for clinical. J Psychiat Res 1975; 12: 189-198.
22) Hanyu H, Shimuzu S, Tanaka Y, Takasaki M, Koizumi K, Abe K: Cerebral blood flow patterns in Binswanger's disease: a SPECT study using three-dimensional stereotactic surface projections. J Neurol Sci 2004; 220: 79-84.
11) Matsuda H, Yagishita A, Tsuji S, Hisada K: A quantitative approach to technetium-99m ethyl cysteinate dimer: a comparison with technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 1995; 22: 633-637.
7) Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, et al.: Frontotemporal lobar degeneration-A consensus on clinical diagnostic criteria. Neurology 2006; 51: 1546-1554.
3) Joseph R: Frontal lobe psychopathology: mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia. Psychiatry 1999; 62: 138-172.
26) Sonohara K, Kozaki K, Akishita M, Nagai K, Hasegawa H, Kuzuya M, et al.: White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly. Geriat Gerontol Int 2008; 8: 93-100.
1) Marin RS: Deferential diagnosis and classification of apathy. Am J Psychiatry 1990; 147: 22-30.
9) Dick JP, Guiloff RJ, Stewart A, Blackstock J, Bielawska C, Paul EA, et al.: Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry 1984; 47: 496-499.
19) Ott BR, Noto RB, Fogel BS: Apathy and loss of insight in Alzheimer's disease: a SPECT imaging study. J Neuropsychiatry Clin Neurosci 1996; 8: 41-46.
4) Tekin S, Cummings JL: Frontal-subcortical neuronal circuits and clinical neuropsychiatry: an update. J Psychosom Res 2002; 53: 647-654.
21) Craig AH, Cummings JL, Fairbanks L, Itti L, Miller BL, Li J, et al.: Cerebral blood flow correlates of apathy in Alzheimer disease. Arch Neurol 1996; 53: 1116-1120.
18) Robert PH, Darcourt G, Koulibaly MP, Clairet S, Benoit M, Garcia R, et al.: Lack of initiative and interest in Alzheimer's disease: a single photon emission computed tomography study. Eur J Neurol 2006; 13: 729-735.
14) Frith CD, Friston KJ, Ashburner J, et al.: Principles and methods, In: Human Brain Function, Frackowiak RSJ, Friston KJ, Frith CD, Dolan RJ, Mazziotta JC (eds), Academic Press, San Diego CA, 1997, p3-159.
17) Benoit M, Koulibaly PM, Migneco O, Darcourt J, Pringuey DJ, Robert PH: Brain perfusion in Alzheimer's disease with and without apathy: a SPECT study with statistical parametric mapping analysis Brain perfusion correlates of the apathy inventory dimensions of Alzheimer's disease. Psychiatry Res 2002; 15: 103-111.
References_xml – reference: 25) Levy R, Czernecki V: Apathy and the Basal Ganglia. J Neurol 2006; 253: vii54-vii61.
– reference: 1) Marin RS: Deferential diagnosis and classification of apathy. Am J Psychiatry 1990; 147: 22-30.
– reference: 9) Dick JP, Guiloff RJ, Stewart A, Blackstock J, Bielawska C, Paul EA, et al.: Mini-mental state examination in neurological patients. J Neurol Neurosurg Psychiatry 1984; 47: 496-499.
– reference: 10) Toba K, Nakai R, Akishita M, Iijima S, Nishinaga M, Mizoguchi T, et al.: Vitality index as a useful tool to assess elderly with dementia. Geriatrics and Gerontology International 2002; 2: 23-29.
– reference: 8) Folstein MF, Folstein SE, McHugh PR, Mini-Mental State: A practical method for grading the cognitive state of patients for clinical. J Psychiat Res 1975; 12: 189-198.
– reference: 13) Takeuchi R, Sengoku T, Matsumura K: Usefulness of fully automated constant ROI analysis software for the brain: 3DSRT and FineSRT. Radiat Med 2006; 24: 538-544.
– reference: 16) Starkstein SE, Ingram L, Garau ML, Mizrahi R: On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry 2005; 76: 1070-1074.
– reference: 23) Hirao K, Ohnishi T, Hirata Y, Yamashita F, Mori T, Moriguchi Y, et al.: The prediction of rapid conversion to Alzheimer's disease in mild cognitive impairment using regional cerebral blood flow SPECT. Neuroimage 2005; 1014-1021.
– reference: 11) Matsuda H, Yagishita A, Tsuji S, Hisada K: A quantitative approach to technetium-99m ethyl cysteinate dimer: a comparison with technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 1995; 22: 633-637.
– reference: 21) Craig AH, Cummings JL, Fairbanks L, Itti L, Miller BL, Li J, et al.: Cerebral blood flow correlates of apathy in Alzheimer disease. Arch Neurol 1996; 53: 1116-1120.
– reference: 20) Benoit M, Dygai I, Migneco O, Robert PH, Bertogliati C, Darcourt J, et al.: Behavioral and psychological symptoms in Alzheimer's disease: Relation between apathy and regional cerebral perfusion. Dement Geriatr Cogn Disord 1999; 10: 511-517.
– reference: 4) Tekin S, Cummings JL: Frontal-subcortical neuronal circuits and clinical neuropsychiatry: an update. J Psychosom Res 2002; 53: 647-654.
– reference: 7) Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, et al.: Frontotemporal lobar degeneration-A consensus on clinical diagnostic criteria. Neurology 2006; 51: 1546-1554.
– reference: 24) Tatemichi TK, Desmond DW, Prohovnik I: Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung 1995; 45: 371-385.
– reference: 12) Takeuchi R, Yonekura Y, Matsuda H, Konishi J: Usefulness of a three-dimensional stereotaxic ROI template on anatomically standardised 99mTc-ECD SPET. Eur J Nucl Med Mol Imaging 2002; 29: 331-341.
– reference: 6) Sheikh JI, Yesavage JA: Geriatric depression scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontol 1986; 56: 165-173.
– reference: 22) Hanyu H, Shimuzu S, Tanaka Y, Takasaki M, Koizumi K, Abe K: Cerebral blood flow patterns in Binswanger's disease: a SPECT study using three-dimensional stereotactic surface projections. J Neurol Sci 2004; 220: 79-84.
– reference: 14) Frith CD, Friston KJ, Ashburner J, et al.: Principles and methods, In: Human Brain Function, Frackowiak RSJ, Friston KJ, Frith CD, Dolan RJ, Mazziotta JC (eds), Academic Press, San Diego CA, 1997, p3-159.
– reference: 18) Robert PH, Darcourt G, Koulibaly MP, Clairet S, Benoit M, Garcia R, et al.: Lack of initiative and interest in Alzheimer's disease: a single photon emission computed tomography study. Eur J Neurol 2006; 13: 729-735.
– reference: 17) Benoit M, Koulibaly PM, Migneco O, Darcourt J, Pringuey DJ, Robert PH: Brain perfusion in Alzheimer's disease with and without apathy: a SPECT study with statistical parametric mapping analysis Brain perfusion correlates of the apathy inventory dimensions of Alzheimer's disease. Psychiatry Res 2002; 15: 103-111.
– reference: 2) Okada K, Kobayashi S, Yamagata S, Takahashi K, Yamaguchi S: Poststroke apathy and regional cerebral blood flow. Stroke 1997; 28: 2437-2441.
– reference: 19) Ott BR, Noto RB, Fogel BS: Apathy and loss of insight in Alzheimer's disease: a SPECT imaging study. J Neuropsychiatry Clin Neurosci 1996; 8: 41-46.
– reference: 5) Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 1993; 50: 873-880.
– reference: 27) 小林祥泰: 脳血管性認知症の治療と予防: 老年期認知症の克服をめざして. 長寿科学振興財団, 2002, p216-218.
– reference: 3) Joseph R: Frontal lobe psychopathology: mania, depression, confabulation, catatonia, perseveration, obsessive compulsions, and schizophrenia. Psychiatry 1999; 62: 138-172.
– reference: 26) Sonohara K, Kozaki K, Akishita M, Nagai K, Hasegawa H, Kuzuya M, et al.: White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly. Geriat Gerontol Int 2008; 8: 93-100.
– reference: 15) Talairach J, Tournoux P: Co-planar stereotaxic atlas of the human brain. Thieme Verlag, Stuttgart 1998.
SSID ssib058494660
ssj0055462
ssib002821993
ssib005879752
ssib000994798
ssib000940319
Score 1.7790662
Snippet 目的:認知症高齢者の日常生活機能に関する意欲の変化に呼応する脳血流変化を脳血流SPECT検査を用い画像統計解析し,脳内における生活意欲関連領域を特定する.方法:対...
SourceID jstage
SourceType Publisher
StartPage 615
SubjectTerms SPECT
Vitality Index
意欲
深部白質病変
認知症
Title 認知症高齢者の意欲低下に関連する脳血流分布
URI https://www.jstage.jst.go.jp/article/geriatrics/45/6/45_6_615/_article/-char/ja
Volume 45
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
ispartofPNX 日本老年医学会雑誌, 2008, Vol.45(6), pp.615-621
journalDatabaseRights – providerCode: PRVAFT
  databaseName: Open Access Digital Library
  issn: 0300-9173
  databaseCode: KQ8
  dateStart: 19640101
  customDbUrl:
  isFulltext: true
  dateEnd: 99991231
  titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html
  omitProxy: true
  ssIdentifier: ssj0055462
  providerName: Colorado Alliance of Research Libraries
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpR3LbtQwMCpFQlwQT_FWD_iEtiTxI_apcrapKqQiIbVSb5GTbpD2UBBsL5y6UB5SBdx4nBBFXCjiAELqpV-zfex-AVdm7GSbAgdKL95JMh7PI45nvGPb867hHlmyyFVDMVo0GF_wGyqDmKdo5RnLDTjM9oylmVtieo7dnOfzI0d-1rKWljrZeP7wr-tK_seqcA_siqtkD2DZIVG4ATDYF0qwMJT_ZGOSSKI1kZMkiYiaIppbICIQ4SeK6JgoiUA8SXSIyNInEnAo-I9EJyQRRIIvOYWAbpIYcBgiy8QCgB9XyDHSUcLSUUhH0_KRUhYILbJEgjG1jAWIBpRjjmgJlPBUIICUad0tRjRgG_kHoInMlNzaijGIwCwFYDJGQINEwjLZJEpb3kDYoFLIcOrXSk9LxcQJCgfvFF5onyhmKezH59i-Cm1rCSrV4nO8Ba2joiTwU6evgMEIW459C9hLVTZkxdeqTh8UD5pAtAB1VvEDTfiWSlgKCzK6M06HszJy2IMq-9gaQA0VBjQYyojMxtY-AmUH9pyUsb5-SD3XRg3qQ3cL3Pkw1RDnduwsu3J9vBJuLW3p-gi3WP33UZWCTw1d4Q52HDw24sE44-PDmvs2Ky-7QrqHmzKeCldAlbRCwDWFaRsCm6NhBN8DzKa4XYsLFMPVdbVrxaLavEAoQ0w83RtIZKQiPvTTwanGYxP8yiXDTMzy70SnG5fegHLd-EMqcEXbEJhVSZ3Wz5w96Z0oA8Qx7SQ45Y20zWnv2EyZAnPGm-h_frH7_tPum2eD9beDzbX-8pNe9-vOyqudL9-2Nl9ubaz2uuuD12uD5Y-97rveo9X-yvf-h-WdH93t50-3Nx6f9eamktnmdKM8BaXRDqQwjYIJGCSNygzPpBS-KqTKVdYKaF7Aj2-iPBMGwjIqjKJioYCQxXATyCjzTUEzes4bXby72DrvjbW4T4uC81yxguUhM0wUkWE0s9uIivyCN-FET--5rW7Sg9rz4qEpXPKOu5QsnOW87I127i-1roDf38mu2nfkF54Wzm8
linkProvider Colorado Alliance of Research Libraries
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E8%AA%8D%E7%9F%A5%E7%97%87%E9%AB%98%E9%BD%A2%E8%80%85%E3%81%AE%E6%84%8F%E6%AC%B2%E4%BD%8E%E4%B8%8B%E3%81%AB%E9%96%A2%E9%80%A3%E3%81%99%E3%82%8B%E8%84%B3%E8%A1%80%E6%B5%81%E5%88%86%E5%B8%83&rft.jtitle=%E6%97%A5%E6%9C%AC%E8%80%81%E5%B9%B4%E5%8C%BB%E5%AD%A6%E4%BC%9A%E9%9B%91%E8%AA%8C&rft.au=%E9%B3%A5%E7%BE%BD%2C+%E7%A0%94%E4%BA%8C&rft.au=%E5%9C%92%E5%8E%9F%2C+%E5%92%8C%E6%A8%B9&rft.au=%E9%95%B7%E8%B0%B7%E5%B7%9D%2C+%E6%B5%A9&rft.au=%E5%AE%88%E5%B1%8B%2C+%E7%A5%90%E8%B2%B4%E5%AD%90&rft.date=2008&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E8%80%81%E5%B9%B4%E5%8C%BB%E5%AD%A6%E4%BC%9A&rft.issn=0300-9173&rft.volume=45&rft.issue=6&rft.spage=615&rft.epage=621&rft_id=info:doi/10.3143%2Fgeriatrics.45.615&rft.externalDocID=article_geriatrics_45_6_45_6_615_article_char_ja
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0300-9173&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0300-9173&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0300-9173&client=summon